Active NPI
Katie Petasek
- School Registered Nurse
- Green Bay, WI
National Provider Identifier
1104756113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Registered Nurse
- License
- 240473
- Practice address
- 2706 Lineville Rd
Green Bay, WI 54313-7151 - Phone
- (920) 808-5875
- NPI assigned
- May 21, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Registered Nurse | 163WS0200X | 240473 | WI | Primary |
Addresses
Primary practice location
2706 Lineville Rd
Green Bay, WI 54313-7151
Mailing address
2706 Lineville Rd
Green Bay, WI 54313-7151
Phone (920) 808-5875
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 240473 | WI | MD | School Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1779321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779321600000",
"number": "1104756113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2706 LINEVILLE RD",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543137151",
"telephone_number": "920-808-5875"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2706 LINEVILLE RD",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543137151",
"telephone_number": "920-808-5875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETASEK",
"first_name": "KATIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-05-21",
"last_updated": "2026-05-21",
"certification_date": "2026-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "163WS0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, School",
"state": "WI",
"license": "240473",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.